Monday, 14 July 2014

Is there a cost to establishing and maintaining a
Quality Management System?

In
answering this question many people will readily recognize that we have to
spend money on preventing 'bad' things from happening, such as defective parts
in manufacturing or an avoidable critical incident in a nursing home. We also
have to lay out money in what are known as 'appraisal costs' such as quality
control on the production line or double-checking that the correct medication
was given to the correct patient/resident at the correct time or covering the
costs of auditors or accreditation surveyors.

But to be
fair and accurate, whenever we have to calculate and report the cost of quality
we should also identify and add in the Cost Of Poor Quality (COPQ) also called
PONC - Price of Non-Compliance or Non-Conformance.

For
example: time spent 'fixing' problems, retooling, speaking to unhappy family
members in a Long-Term Care Home, covering staff absences because of stress and
demotivation and, of course, time spent with inspectors for reported complaints
or critical incidents should all be seen as “waste” and added to the cost of
poor quality.

Of
course, there is also the cost of lost reputation when our failures become
public knowledge, which also adds to staff stress and demotivation. Inspection
reports are really dirty laundry hanging on a very public clothes line.

To the
extent that our preventive and appraisal efforts are reducing the incidence of
poor quality and non-conformance and the associated costs, we are receiving a
return on investment in our Quality Management System.

There is
a tax benefit to reporting money spent on quality as a cost of doing business,
but in our minds and hearts we would do better to see that money as a capital
investment that produces a return. Then we are more inclined to ask, How can we
get the best ROI, Return On Investment? This question is not limited to for-profit
organizations.

An efficient and effective QMS is really an asset, not
a cost:

Ask: How can we get a return
on investment? (Note. This question applies equally to NFPs as
For-Profits)

It’s a shame and a waste to
use accreditation or certification mainly for ‘window dressing’

Time and resource spent on
preventable complaints and inspections for reportable events should be
cost out as ‘waste’ (COPQ, PONC). Any reduction is ROI.

Wednesday, 9 July 2014

All Long-Term Care Homes have got the on-going challenges of heading off resident complaints at the pass and preventing avoidable critical incidents. Many have got these pain points satisfactorily under control. Many others are struggling with this challenge and finding that they are triggering unwanted inspections from the Ontario Ministry of Health and Long-Term Care.

Firstly:
Are we measuring all
the right things? Of course, we are measuring for CIHI and HQO and our own
Board meetings, but have we got the metrics in place to red flag the likelihood
of an avoidable critical incident occurring, to red flag the future likelihood
of one or more resident complaints that could trigger an inspection? In the
field of quality management we call this type of metric KPIs, Key Performance
Indicators. KPIs are the organization’s "vital signs", the vital few
metrics that report on the health of the organization in living out its mandate
from and to society. KPIs should not be confused with the kind of quality
indicators that are reported to HQO such as falls, wounds and restraints,
although KPIs might well incorporate some of those metrics.

Secondly:
Are we monitoring
effectively? Assuming that we actually do measure those KPIs, are we reporting
them in an accountable manner to the right people who are best positioned to
effect change – change in our processes and change in our culture? Managers and
others in positions of responsibility who are not being fed the information
they need to do their job need to report this as a concern up the management
chain. Without KPIs you are flying blind.

Thirdly:
Are we managing
efficiently and effectively? Assuming that we are reliably measuring and
monitoring KPIs, are the process owners and managers sufficiently trained,
mandated, empowered, resourced and accountable to take the actions necessary to
enhance the Quality Management System (QMS) and foster a culture of quality to
prevent the bad stuff happening? If not, that is fodder for a KPI in itself and
needs to be reported as a resourcing issue to senior management. Managers and
others in positions of responsibility who feel they need training need to do
whatever it takes to get it; if your department is at risk for non-compliance
because you are lacking resources then that needs to be reported, repeatedly if
necessary.